Provider Demographics
NPI:1750460085
Name:TYVOLA CHIROPRACTIC CENTRE PA
Entity Type:Organization
Organization Name:TYVOLA CHIROPRACTIC CENTRE PA
Other - Org Name:HUNT CLINIC OF CHIROPRACTIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TUNIS
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:704-588-1792
Mailing Address - Street 1:9422 S TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28273-6500
Mailing Address - Country:US
Mailing Address - Phone:704-588-1792
Mailing Address - Fax:704-588-2718
Practice Address - Street 1:9422 S TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-6500
Practice Address - Country:US
Practice Address - Phone:704-588-1792
Practice Address - Fax:704-588-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC983111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08502OtherBCBSNC
NC4317470OtherAETNA
NC2446556Medicare ID - Type UnspecifiedMEDICARE
NC4317470OtherAETNA